Are Pancreas Transplants from Parents an option for Children with Type 1 diabetes?

I met one of the world’s leading diabetes research scientists this week and asked him the question every parent of a child with diabetes has wanted an answer to:

I’d much rather have diabetes myself than see my child have diabetes. Why can’t I donate my islet cells to my child to cure their diabetes, just like other parents do with children who need kidneys and other organs?

Most parents would give their pancreas to their child in a New York minute to cure their diabetes. So I asked. He told me that it would never work, for a number of reasons:

• The pancreas is a collection of ducts, and only two percent of the pancreas is used to produce hormones, insulin being one of them. The rest of the pancreas produces digestive enzymes that are secreted throughout the gut during digestion. It would be extremely difficult to separate out the insulin-producing cells on a live donor during surgery – you’d have to take out the whole pancreas and then harvest the islet cells under a microscope.

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• The pancreas is very difficult to reach during surgery because of its location, and so the surgery would be very long, with an extended recovery time. After what he called a “pancreatectomy” you would be “viciously” diabetic -- worse than your child – and in really bad shape because you’d have no digestive enzymes.

• Because the rest of the pancreas is full of digestive enzymes, it “self-digests,” meaning the islet cells must be removed very quickly before the digestive enzymes break them down. This is why it takes more than one cadaver to get enough islet cells for an islet cell transplant (which was another question I asked him). So if you donated your pancreas to your child, they might not be able to harvest enough cells to do any good.

• Your child, meanwhile, would have to be on immuno-suppressive drugs to stop the rejection that could take place from receiving your islet cells. Often these drugs are worse than having diabetes – causing major damage to other organs, like the kidneys and liver, and putting them in a situation where they’d have no resistance to everyday germs like colds and the flu.

• Finally, the doctor said, you’d be curing one person of diabetes while creating another person with the disease – not a net gain for the world at large. Parents who give their child a kidney, for example, can still live a good life on one kidney. Once your pancreas is gone, you don’t have another you can live on.

This particular doctor was very excited about cell regeneration and the promise it holds for a cure, because it doesn’t rely on donor issues such as these. He also is heavily involved in designing the algorithms for a closed-loop artificial pancreas, which he predicts will be available within five years. There’s a lot of hope!